Symptomatic pleural effusion after coronary artery revascularization: unsuspected pleural injury from internal mammary artery resection.

A patient with a large left pleural effusion returned to her physician 4 weeks after CABG with saphenous vein grafts. After repeated investigations the cause of the effusion still could not be ascertained. Upon subsequent review it was noted that the patient had had an aborted attempt at coronary artery revascularization using the left IMA. Nonsurgeons frequently fail to recognize the association of significant pleuropulmonary complications with harvesting of the IMA conduit as a coronary bypass graft. The delay in presentation of these complications after CABG, along with a lack of physician familiarity with them, can lead to problems in diagnosis and management. Although serious pleuropulmonary complications are an uncommon problem, physicians must become familiar with these complications because of the widespread use of the IMA graft.